Comparative assessment of traditional methods of surgical treatment of secondary hyperparathyroidism in patients with chronic kidney disease

Introduction. Secondary hyperparathyroidism is one of the most frequent complications of chronic kidney disease. In the treatment of patients with severe hyperparathyroidism there is no consensus in the choice of surgical tactics.

Aim of the study. To evaluate the effectiveness and safety of surgical treatment of patients with secondary hyperparathyroidism using traditional methods of surgery.

Materials and methods. The data of medical records of 85 patients with secondary hyperparathyroidism and chronic kidney disease were subjected to retrospective analysis of treatment results. Of them, subtotal parathyroidectomy was performed in 58 cases, in 27 cases – total parathyroidectomy with autotransplantation of perithyroid glands into forearm muscles. A comparative evaluation of postoperative complications, changes in parathormone level, incidence of persistence and recurrence of the disease depending on the type of intervention was performed.

Results. In 36,2 % of observations after subtotal parathyroidectomy the level of parathormone did not reach the recommended values for dialysis patients. In patients who underwent total parathyroidectomy, postoperative hypocalcemia was detected more often (p<0,05). The mean length of hospital stay was also higher in these patients (p<0,05). Laryngeal nerve paresis was detected in 2 (3,4 %) patients who underwent subtotal parathyroidectomy and 3 (11,1%) who underwent total parathyroidectomy.

Conclusion. Postoperative hypocalcemia was more common in patients who underwent a larger intervention. Subtotal parathyroidectomy was associated with more frequent recurrences of the disease. Total parathyroidectomy did not increase the risk of laryngeal nerve paresis.

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